Budget Impact Analysis of Sacubitril/Valsartan in the Treatment of Heart Failure with Reduced Ejection Fraction (HFrEF) in Indonesia

Abstract

Based on PARADIGM-HF Clinical Trials, LCZ696, a dual-acting sodium supramolecular complex currently known as sacubitril/valsartan, was superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF) in patients with heart failure and reduced ejection fraction (HFrEF). This analysis aimed to estimate the budget impact of sacubitril/valsartan in the treatment of HFrEF in Indonesia setting. A budget impact model estimated the impact with and without the use of sacubitril/valsartan for a 5-year horizon (2020 - 2024). The local data inputted in the model included age prevalence rates, drugs costs, HF hospitalization costs, and adverse events costs. The drug cost calculation of sacubitril/valsartan was from the regular price, while standard care drug costs mainly came from e-catalog price, which was reimbursement cost. The budget impact was estimated from the budget difference between the future scenario therapy and the current therapy. In the current therapy, the target population was treated without sacubitril/valsartan. Meanwhile in the future scenario therapy, the target population was treated with sacubitril/valsartan based on a market penetration rate of 6%, 12%, 18%, 24%, and 31% in the first, second, third, fourth and fifth years, respectively. Given that the number of patients eligible for treatment was estimated as 86,594 in the first year, and the assumption that the annual increase of HF prevalence was 1.1% based on population growth, about 1,350 deaths and 3,512 hospitalizations may be avoided over five years. The scenario of implementing sacubitril/valsartan for HF treatment had an impact on an additional budget of 1%, 2%, 3%, 4%, 5% over a 5-year horizon compared to the current therapy strategy. This scenario resulted a cumulative budget impact of IDR 735 billion over five years. This analysis estimates the impact of sacubitril/valsartan application in the treatment of patients with HF and reduced ejection fraction as input for Indonesia healthcare payer in implementing the strategy for HF treatment.